MEDICARE: EDGAR GONZALEZ FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11024520	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407553423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR GONZALEZ FNP-BC

Provider Business Mailing Address
First Line	:	4224 ANSON LN APT 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6089
Country	:	US
Telephone Number	:	864-764-2375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3322
Country	:	US
Telephone Number	:	689-240-4646
Fax Number	:	866-321-8536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	01/13/2026

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